Effectiveness Over Time & Delta

On Sunday, Metropole brings you a COVID-19 update from Prof. Dr. Florian Krammer, an Austrian virologist who works and teaches at the Icahn School of Medicine at Mount Sinai, New York City.

April 18, 2021

And again my weekly coronavirus update.

There have been 141 million official SARS-CoV-2 infections registered worldwide so far. Over 3,025,000 people have officially died from COVID-19. The international trend is unfortunately steeply upward at the moment. 884 million doses of vaccine have been administered so far (i.e., about 100 million per week worldwide at the moment).

The good news first.

Falling Numbers in Europe

In Europe, the numbers are dropping in many countries (France, Italy, Poland. Ukraine, Czechia, Romania, Bulgaria, Hungary, Serbia, Slovenia, Greece, Slovakia, Finland, Norway and also Austria). I hope we are over the hill, there. In Portugal, Great Britain and Denmark, case numbers are currently quite low and stable.

However, in some countries, case numbers are still going up or the peak seems not to be reached yet (Germany, Spain, Croatia, Netherlands, Sweden, Switzerland etc.). But basically the outlook is optimistic. Maybe that’s it soon. I still hope for a seasonal effect that, combined with more and more vaccinations, will end the story.

Cautionary Optimistic for the US, Strong Waves in Canada & South America

Despite slight increases in cases, the US still looks surprisingly good. The problem children here are Michigan and parts of Texas, with the rest of the country I am quite happy. It looks like we’re winning the race between virus and vaccines here at the moment. Canada is in the middle of a pretty strong wave, unfortunately. Cases in Mexico are still on the way down, so it looks good.

Central America is doing OK. However, almost all of South America is in a strong fall wave. The situation in Brazil is drastic, although they seem to have a slight downward trend in terms of infections.

Troubles and Rising Case Numbers in Asia

In Asia, things are not looking so rosy at the moment, either. India seems to show exponential growth, with many sad records in the last week. The neighboring countries, Pakistan and Bangladesh, seem to be over the crest of the wave, but in India there is still no turnaround to be seen, on the contrary.

In some other countries, Malaysia, Philippines but also Japan, cases are also going up at the moment. Cases are now also rising in Thailand, let’s see if they can stop that rise. For Thailand, it would be the first pandemic wave.

Worries in the Middle East, Hope in Africa

In the Middle East, case numbers in Turkey, Iran and Iraq are on the rise, but Egypt is also seeing an upward trend and there are slight increases in the Maghreb.

In Israel, the pandemic is over (at least for now). They are down to 100-200 cases per day and very few deaths, even though they have fully opened up. The vaccination rate has reached almost 60% (and is now somewhat stagnant), plus immunity from infections.

Further south, Ethiopia and Kenya are apparently over the peak, Gabon is in the middle of a wave, but most of Africa is looking good. South Africa is also holding up very, very well with few cases.

The Pause of the Johnson & Johnson Vaccine

As you have probably heard, use of the J&J vaccine has been paused in the US (and the start of vaccination in Europe basically postponed). The reason for this are 6 cases of sinus vein thrombosis that were recorded after about 7 million people in the US were vaccinated with the vaccine.

J&J’s vaccine is also an adenovector vaccine like AstraZeneca (and Sputnik V and CanSino). It is therefore now reasonable to assume that the thrombosis problem is caused by the adenovector vaccine platform. There was a (publicly available – this was broadcast live) meeting of the ACIP (similar to the vaccination panel in Austria) last week where this was discussed and where it was agreed that more data was needed.

The ACIP will meet again next Friday (April 23) and will probably recommend the continued use of the vaccine – precisely because the rate of sinus vein thrombosis is very, very low. However, I assume there will be warnings for people giving the vaccine and physicians to be more aware of any symptoms of sinus vein thrombosis (I’ll keep you posted on that next week as well).

What Can I Do When I Am Vaccinated?

One more thing on another topic, because inquiries came in – and because I promised to write about it a few weeks ago:

If I am vaccinated, what can I do safely now?

Basically, you already have partial protection about 2 weeks after the first vaccination (mRNA, AstraZeneca, etc.), but you are fully protected only about 2 weeks after the second vaccination. Everything I write here concerns people who have received both vaccinations and have full protection.

First, what do we know?

Vaccines offer excellent protection against symptomatic diseases. The protection offered by mRNA vaccines is over 90%, and for AstraZeneca I would expect 80-85% at the moment. For mRNA vaccines, about 90% protection against infections has also been shown (there are no data on AstraZeneca yet).

Most of the infections in vaccinated people are caused by variants, but even then there is only little virus present and in Israel it was shown that the virus is then mostly not passed on. So all in all, very very great!

But what you have to keep in mind is that vaccination is a risk reduction, but cannot provide 100% protection. If there is a lot of virus in the population, there is a high risk of infection. This is then reduced by the vaccination by 90%. But because the risk is high when there is a lot of virus, the probability of getting infected is still there.

If there is very little virus in a population, the situation is different because the risk of infection is very small. If one is then still vaccinated, it becomes vanishingly small.

Safe Behavior, in Private and in Public

So, that is the starting position.

What can you do now if you are vaccinated?

Basically, I would follow all the prescribed rules in public life (masks, keep your distance, etc.) and continue to avoid crowds. In private, however, it is different.

A gathering of people who are fully vaccinated – even indoors and without masks – probably carries very little risk.

  • If someone among the vaccinated is infected, they probably won’t be able to pass on the virus.
  • If the virus is passed on, it is unlikely to cause illness because the others are vaccinated.

For example, we have started meeting vaccinated friends for coffee or dinner again, and I don’t see any problem with that at all. Of course, I’m not talking about parties of 30 people, but small groups. And with unvaccinated people we still only meet outdoors.

What About Situations Where Some Are Vaccinated & Some Not?

Then there is the “vaccinated grandparents – unvaccinated grandchildren” situation. Again, I would say that the risk is low. The grandparents are protected, and if the grandparents have an asymptomatic infection despite their vaccination, it is unlikely that they will infect the grandchildren.

The “vaccinated parents – unvaccinated children” situation is, of course, the same, although unvaccinated adults are at greater risk of symptomatic disease than children.

In households where there are vaccinated and unvaccinated persons, it is of course recommended that the vaccinated persons take over necessary activities with higher risk, for example shopping (unless the vaccinated persons are high-risk persons).

Christine was vaccinated in the fall and I was vaccinated in January (before that, I got a placebo in the clinical trial). After we were informed about who was vaccinated and who was not, Christine took over things like shopping etc. to minimize the risk for me.

By the way, there are reinfections, but a passed infection protects very well against another infection. I would rate people who have already had SARS-CoV-2 as protected (although at least one dose of vaccine is recommended for these people to achieve a high antibody titer).

Some Final Points

Not everyone responds with a strong immune response to vaccination. There are people who have problems with the immune system, and this is also more common in older people. If this is known, it would be good to check the reaction to the vaccination with an antibody test. The best time is two weeks after the second vaccination.

The test must be specific for the spike antigen, a nucleocapsid antibody test is useless, this protein is not contained in the vaccine. If the test is positive or you have a measurable titer you are probably well protected. If you have no reaction, you may still be protected by other immune mechanisms, but in that case I would still be very careful and consider myself rather unprotected.

As I said, these tests only make sense for people who have problems with the immune system. In healthy people I would not worry about the immune response/protection.

So, that’s it again.

Greetings from New York!

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Prof. Dr. Florian Krammer
Prof. Krammer is the Principal Investigator of the Sinai-Emory Multi-Institutional Collaborative Influenza Vaccine Innovation Center (SEM-CIVIC). Currently Prof. Krammer holds a position as a Professor of Vaccinology at the Department of Microbiology at the Icahn School of Medicine at Mount Sinai. He has published more than 100 papers, is member of the editorial boards of the Journal of Virology, Plos One and Heliyon and is a peer reviewer for more than 30 journals.

Current Status

If you live in Vienna, make sure to register for getting a vaccine against COVID-19 under impfservice.wien.  Here you can book your vaccination appointment.

The City of Vienna offers free vaccinations without an appointment to everyone – regardless of citizenship, residency or insurance status – at multiple locations across the city. 

Vienna has reinstated a number of coronavirus restrictions for the fall. The Austrian government has presented a plan for schools and universities.  

Here’s an overview of where you can get tested for COVID-19 in Vienna and how the free PCR “gargle” tests at home work. 

If everything is a bit much for you or you experience domestic violence of any kind, here is our mental health resource article.

Numbers

For current coronavirus numbers, check the website of Ministry of Health and the AGES dashboard.

The Austrian Ministry of Health also publishes daily vaccination statistics and a preview of scheduled deliveries.

Resources

The City of Vienna has compiled comprehensive information on questions and answers regarding coronavirus and the COVID-19 disease in English.

The Austrian Ministry of Health has put together FAQs on the coronavirus and also provides material to download on how to protect yourself and others from the disease, also in English.

Furthermore, the ministry will constantly update its German-language website with information on the number of people tested and cases of COVID-19 in Austria.

Hotlines

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If you show symptoms (fever, cough, shortness of breath, breathing difficulties) or fear that you are ill, stay at home and dial health number 1450 for further procedures (diagnostic clarification).

Coronavirus hotline AGES+43 0800 555 621

The Austrian Agency for Health and Food Safety (AGES) answers questions about the coronavirus (general information on transmission, symptoms, prevention) 24 hours a day at +43 0800 555 621.

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